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Alzheimers Dement (N Y). 2018 Apr 9;4:141-149. doi: 10.1016/j.trci.2018.03.003. eCollection 2018.

Wishes and preferences for an online lifestyle program for brain health-A mixed methods study.

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Alzheimer Center, Department of Neurology, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, the Netherlands.
Medical Faculty, Department of Psychiatry, University Hospital Cologne, Cologne, Germany.
Alzheimer's Disease and Other Cognitive Disorders Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Department of Medical Humanities, VU University Medical Center/EMGO+, Amsterdam, the Netherlands.
Barcelona βeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain.
German Center for Neurodegenerative Disorders (DZNE), Bonn-Cologne, Germany.
Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands.



Individuals with subjective cognitive decline (SCD) are at increased risk of Alzheimer's disease and could benefit from a prevention strategy targeting lifestyle factors. Making a program available through the Internet gives a widespread reach at low cost, but suboptimal adherence is a major threat to effectiveness. As a first step in developing an online lifestyle program (OLP), we aimed to identify factors that are barriers and/or facilitators for the use of an OLP in individuals with SCD in three European countries.


As part of the Euro-SCD project, SCD subjects were recruited at memory clinics in the Netherlands, Germany, and Spain. We combined quantitative and qualitative methods, using a mixed methods approach. We conducted an online 18-item survey on the preferences of SCD patients for an OLP (N = 238). In addition, we held semi-structured interviews (N = 22) to gain in-depth understanding of factors acting as a facilitator and/or barrier for intended use of an OLP. Audio recordings were transcribed verbatim. Content analysis was performed.


One hundred seventy-six individuals completed the survey (response rate 74%). Almost all participants regularly use the Internet (97%). Participants reported trustworthiness (93%), user-friendliness (91%), and up-to-date information (88%) as main facilitators, whereas having contact with other users (26%), needing an account (21%), and assignments (16%) were reported as barriers. Barriers differed slightly between countries, but facilitators were largely similar. In-depth interviews revealed that both program characteristics (e.g., trustworthiness, user-friendliness, and personalization) and personal factors (e.g., expectancy to receive negative feedback) are likely to influence the intended use of an OLP.


Involving users provided in-depth understanding of factors associated with the intended use of an OLP for brain health. Both program characteristics and personal factors are likely to influence the use of an OLP. Based on this input from the end-users, we will develop an OLP for individuals with SCD.


Alzheimer's disease; Brain health; Co-creation; Cognition; Dementia; E-health; Mixed methods; Online lifestyle program; Prevention; Subjective cognitive decline; User participation

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